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ObamaCare Staggers Toward the October 1 Finish Line (5)

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By Lambert Strether of Corrente.

Tonight I want to focus on only two topics: First, the utterly supine nature of the AFL-CIO as led by Richard Trumka.* Obama can’t armwrestle Putin, and Obama couldn’t consummate his bromance with Larry Summers by installing Summers at the Fed. But by gawd, Obama can still whip Big Labor into line! Here’s the backstory from [sigh] Ezra Klein:

A particular issue of contention has been so-called “Taft-Hartley plans” — multi-employer health-care plans that unions run, and that aren’t eligible for subsidies under the terms of the Affordable Care Act. The plans cover about 20 million Americans, and the government treats them as employer-based health-care plans for tax purposes.  A recent letter signed by the powerful Teamster, UNITE-HERE, and UFCW unions warned that “under the ACA as interpreted by the Administration, our employees will be treated differently and not be eligible for subsidies afforded other citizens.”

Ah! A “strongly worded letter”! Continuing:

“As such, many employees will be relegated to second-class status and shut out of the help the law offers to for-profit insurance plans.”

That’s not a bug. It’s a feature.

The unions argue this will decimate membership in their plans as employers dump union workers onto public exchanges.

And that’s not a bug, either. It’s a feature. So of course the administrations stiffs them:

Tonight, the effort failed. A senior administration official tells me that the administration “does not see a legal way for individuals in multiemployer group health plans to receive individual market tax credits as well as the favorable tax treatment associated with employer-provided health insurance at the same time.” A Treasury Department letter is being released that lays out the administration’s reasoning in more detail.

Come on. Since when did this administration ever care about the rule of law? Obama’s perfectly happy not to enforce the employer mandate, for example. Or delay limits on out-of-pocket expenses because health insurance companies didn’t reprogram their systems. Or give Congressional staffers special treatment. We’re seeing the administration bending or breaking the law for constituency after constituency, so when the unions ask for the same kind of deal on behalf of their 20 million members, what happens? Suddenly, everything is strictly by the book! So here’s what happened at last week’s AFL-CIO national convention. Faced with this threat to their membership, what does the AFL-CIO do? Talk softly and carry a soft stick:

One of the most interesting aspects of this story is what happened behind the scenes. Some unions were agitating for the AFL-CIO to pass a resolution calling for the repeal of Obamacare. President Obama personally intervened to prevent that from happening. At the end of the week, once the AFL-CIO’s quadrennial convention was over, the Obama administration announced that it wouldn’t heed labor’s concerns. Politically speaking, the President won, and the unions lost. … [I]ncreasing calls for Obamacare’s repeal from Democrats’ staunchest allies … spooked the White House, on the eve of the AFL-CIO’s quadrennial convention in Los Angeles. … Wednesday was the last day of the AFL-CIO convention, and the President could evade a politically embarrassing debacle by simply stalling the rumored resolution. … The President’s team swung into action. “White House officials have been calling union leaders about a resolution critical of Obamacare that is set to pass on Wednesday at the AFL-CIO convention,” he reported last week. “Union leaders have been tight-lipped about the calls coming from Washington, but at least one labor official said he understands that the Obama administration has been watching the resolution’s progress and expressing a desire that it not move forward.”**

Wowsers. There are certainly many people more knowledgeable about union politics than I am, so maybe I’m being overly simplistic. But IMNSHO, if you can’t appeal to Obama’s greed, you’ve got to work on his fear. That’s what the gay bundlers and Hispanics did before election 2012, and at least they came away with something, while the more docile environmentalists got nothing. If the AFL-CIO had passed a resolution calling for ObamaCare’s repeal and its replacement by single payer, you can bet they’d be in a stronger position to protect their members.

I mean, come on. SEIU, not in the AFL-CIO, sold themselves to Obama back in 2009-2010 (and funded front groups and “progressive” bloggers to suck away all the oxygen from single payer, too). And sure, they helped put in place a rotten public policy that leaves millions without coverage even when fully implemented, can’t control costs, and reinforces the dominance of completely parasitical health insurance companies. But at least they got a million in walking around money from Covered California! What did AFL-CIO win for their members?

And, oh yeah. When Obama said: “If you like your health care plan, you can keep your health care plan” he was lying. Maybe 20 million union members didn’t know that. But now they do.

And then — second — there’s this. Something I didn’t have a word for, and had to ask for help with. You know how when (say) you start a relationship and it turns out there are more entities in the relationship than you thought there were going to be? Like the sheepdog who has to sleep in the same bed, or the mother who’s always in the back seat, or the eight drinking buddies, plus the dealer and the parole officer? I could get more vivid, but you see what I mean. In a lot of ways, ObamaCare is like one of those relationships, because it’s not a clean, simple relationship, just you and the Exchange website plus the Chat line plus the Navigator plus the Call Center plus the online forums to figure out what’s going on. Nothing so simple, because when it comes time to enter your data, you’ve got the IRS and the DHS and the credit reporting agencies and the Peace Corps and maybe (heaven forfend) the state Medicaid office. But wait! There’s more! Wellness programs. Get a load of this:

Under Penn State’s new employee wellness program, a health risk assessment questionnaire asks female employees if they plan to get pregnant in the next year. If the employee doesn’t want to disclose that and opts out of completing the assessment, she’ll incur a $100 fee each month. That’s $1,200 over the course of the year.

If you’re some poor wage slave of an adjunct, that’s a huge chunk of change. 

But it gets better, because it turns out — this is the eight drinking buddies part — that this extremely personal information is to be shared with a third, profit-making party:

The faculty members’ remarks centered on whether the plan is too invasive by requiring them to provide medical information on the health risk assessment to a third party company, WebMD, and whether the information in databases will be vulnerable to online hackers.

The point about disclosing on the health risk assessment a planned pregnancy was raised by Maria Truglio, an associate professor of Italian in the College of Liberal Arts.

“Is it appropriate that women who refuse to disclose their reproductive plans are fined $100 a month?” said Truglio, whose remark was followed by applause and cheers.

Kim Blockett, an associate English professor at the Brandywine campus, said that kind of information doesn’t belong with an insurance company.

“For me, discussing my reproductive plans with an unknown entity at an insurance company does not constitute ‘private,’ ” she said. “Certainly, I understand the health benefits and the necessity of having that conversation, as part of a larger context, with my physician. That makes sense to me, not my insurance company.”

And the beauty part? The health benefits of so-called wellness plans are at best heavily contested:

The [RAND] study, sponsored by the Labor department and Health and Human Services, found that these programs, designed to save employers money by financially incentivizing healthy behaviors among their workers, don’t do either job particularly well. Generally, improvements in health and their subsequent cost savings were modest and, in most cases, not statistically significant. It also found that employers are likely unaware of these findings, because they are not evaluating their own programs for success. The RAND report suggests that there’s a lot of work yet to be done to evaluate their results. Until the programs are proved be successful, reporters might do well to skip the anecdotes of workplace wellness program success.

However, to be fair, wellness programs do provide yet another site for rentiers to sink their sucking mandibles into. (Even if individual records are private, can the results that WebMD is collected be anonymized, aggregated, and sold to a fourth party? I can imagine plenty of firms who would like to know exactly how many planned pregancies there are likely to be at the university of Pennsylvania; and whether the administration will get a cut when that data is sold. The faculty might consider looking into those angles.) Back to Penn State:

[David Gray, the senior vice president for finance and business] said Penn State’s adoption of a wellness program may seem unique now, but he predicted it’d be commonplace among colleges and universities across the country in a couple years. [Human resources administrator Susan] Basso said Ohio State University and the University of Virginia are rolling out similar programs.

Oh, great. Anyhow, the phrase Yves came up with — the sheepdog in bed, the dealer, and the parole officer part — is “non-consensual entanglement.” I think that fits the case perfectly. Certainly being fined $100 for not telling your insurance company you plan to get pregnant is “non-consensual.” And “entanglement” is perfect as well, since it captures the sense of being trapped in a net from which one is not able to escape. I’m sure that as we all become better acquainted with ObamaCare, many more non-consensual entanglements will emerge.***

NOTE * Not to say that all unions are supine. The National Nurses Union is very strong on single payer. Many locals are strong. Some unions are strong. But the national office in Washington? Forget it!

NOTE ** Bonus quote:

[A] senior administration official told Politico: “The President expressed in the meeting [with the Unions] that he wakes up every day thinking about how to help working Americans and build the middle class.”

And somebody didn’t punch a hole in a wall when they heard that bullshit?

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49 comments

  1. Alexa

    Totally agree that Trumka is a sell-out.

    But, I also believe that some of the unions (especially the ones who have recently unaffiliated with the AFL-CIO) may soon reach a tipping point on the issue of Taft-Hartley.

    [BTW, Alan Simpson has bragged that the hugs and kisses his old friend Rich Trumka, upon seeing him.]

    So, yep, I’d say that Trumpka’s a “lost cause.”

    OTOH, each rank-and-file union member has a vote–and collectively, 20 million voters should have the leverage to greatly affect the outcome of the next two elections (either sitting them out, or voting Republican)–if they should choose to do so.

    Who knows what the rank-and-file will do?

    I don’t, but I will encourage them to put their leverage to good use.

    It is “telling” that the President did NOT send a “stand-in video,” to be shown during the convention, after he cancelled his appearance. And I have searched “high and low,” and find no mention of one.

    Could it be that he was warned of a very negative (and embarrassing) reception?

    Dunno–but it sure wouldn’t surprise me.

    And if things are “so bad” that a video could not be shown, then maybe–just maybe–union “members” are finally ready “to play hardball.”

    With or without Trumka.

    I hope so. ;-)

    1. Lambert Strether

      Good point on the video. Obama basically broke diplomatic relations, didn’t he?

      * * *

      Again, though, the time to inflict pain is when it matters. The AFL-CIO mattered at the Convention before the October 1 launch. Now it doesn’t matter so much. And if these guys think aligning themselves with the Sierra Club is going to help, they’re even more sclerotic and necrotized than I imagined.

  2. Chromex

    OH it gets worse.
    The “employer mandate” is NOT postponed for small employers. The reason , I guess is that small employers do not HAVE to provide insurance under the ACA so participation is “voluntary”,
    I run a small 501 c3. We have a Union and so we are contractually obligated to provide health care benefits. I am supposed to give a notice of beneift avaiability on OCtober 1,(this is mandated under the law) but when I talk to my agent and say “what should I tell them about what our benefits are going to be like next year ?”, which appears to me to be a reasonable question, he says” no one has their plans ready , so I don’t know”. The only thing he CAN tell me is that the current plan will not be offered. We need another Joseph Heller for these times, I am afraid.

    Well, very few Union members take advantage of our healthcare so can we negotiate it out and monetize it?
    Well, we are at a disadvantage because we pay for the premiums ( and the employee contributions are paid) with pretax dollars- if raises are given “in lieu of” benefits, that has to be taken into account and employees will not get the full benefit of whatever premium is paid-and we are told here to expect premium increases of 8 to 12 %.
    NOW we are into Laurel and Hardy “another fine mess” territory!

  3. Don Levit

    Whether wellness programs are effective in reducing medical costs seems to still be a point of contention.
    Mtahematics can lend some objectivity to the discussion.
    Let’s assume, that initially, every person is chaged the same premium – pure comunity rating of 1 to 1 – not 3 to 1, according to age, under the ACA.
    If people have no claims ot pay smaller claims out of pocket, they are provided lower premiums. We then know for certain, after the fact, this individual is saving the insurer money from not paying out claims.
    If claims are filed due to significant medical bills, the person returns back to his original premium – the same premium he paid initially.
    In this system, people are rewarded with lower premiums due to less actual risk to the insurer. Yet, they are not penalized for incurring claims.
    By rewarding people in this manner, the lower risks tend to remain in the pool, thus helping to pay the claims of those who experience misfortunate health.
    Don Levit
    Don Levit

    1. Spring Texan

      Don Levit wrote: “Whether wellness programs are effective in reducing medical costs seems to still be a point of contention.”

      Yes indeed. I suggest reading Al Lewis’s “Why Nobody Believes the Numbers: Distinguishing Fact from Fiction in Population Health Management”.

      Focusing healthcare on the well and not on the sick may be a BIG mistake and one that runs up expenses.

    2. Cynthia

      Wellness programs are based on good ol’ common sense, so these programs should cost hardly anything to run. But the truth of the matter is that those in the wellness industry will find a way to overcharge you for giving out commonsense information. I already see this happening at the hospital where I work. The hospital has recently hired a gold medal winner at the 1999 Pan American games with a PhD in “Human Studies” ( whatever the hell that is) and is paying her six figures to tell employees to do such common sense things like eat right, don’t smoke, look both ways before crossing the street, and always wear a seat belt when your behind the wheel of a car. Sorry, but this is something that a minimum-wage daycare worker is more than qualified to do. What an absolute waste of healthcare dollars!

      _________________

      1. craazyboy

        Methinks wellness should be taught in the public K12 school system, and low cost paperback publications sold in supermarket checkout lines right next to the National Enquirer.

        But I have heard the definition of “wellness” may be changing. A CA buddy, with perfectly good [deductible] insurance, whom recently visited his doctor after waiting 6 weeks for an appointment, inquired about the wait. He was informed that sadly he is now “low priority” because his doctor joined the Broadcom (big semi mfg) “executive wellness program”. Here, upper echelon employees of Broadcom get a paid health plan where doctors agree to give them priority service. Sorta a HMO for VPs and any other employees Broadcom values highly.

  4. Cynthia

    The big problem is that health care and health insurance in America is massively mind-numbingly expensive compared to every other developed country in the world.

    Basically, the medical industry in America is run like a massive criminal cartel that sets prices, controls markets, buys off politicians and collects pay-off money from the masses, which it funnels to corporate insiders.

    ObamaCare is a disaster beyond belief not because it provides benefits to the undeserving or because it is anti-free-market, but because it does nothing to control costs. It keeps the insurance industry firmly in the loop, sucking off its percentage while providing no benefit. And it keeps the current system in place where everything from pills to doctors to hospital stays cost 5 to 10 times as much here as does in the rest of the world.

    1. Jim Haygood

      Thank you for highlighting the big picture, which supersedes technocratic details.

      Just as the U.S. spends 5% of GDP on its military empire, when other advanced nations such as Japan have gotten by (in a dangerous neighborhood) spending 1% of GDP on defense, the U.S. wastes another 4% of GDP on a cartelized health care system which isn’t even competitive (except at the elite, cost-is-no-object level of care) with those of other OECD nations.

      Flush a combined 8% of GDP down the toilet which ought to be invested in improving living standards, and pretty soon you’re a threadbare, delapidated ex-empire. Sic transit gloria mundi. Lords of the flies, as it were.

    2. bh2

      “Basically, the medical industry in America is run like a massive criminal cartel that sets prices, controls markets, buys off politicians and collects pay-off money from the masses, which it funnels to corporate insiders.”

      Yes, that’s the basic government model for running the economy. Why should medicine be an exception?

  5. Goin' South

    The good news is that Obamacare will be the death of the Democratic Party. Good riddance.

    Maybe, just maybe, those disgruntled union members will vote out Trumka and his ilk, cut off the money flow to the Dems and sell that useless palace on 16th Street that overlooks where Obama and his walkin’ shoes abide. After all, what has AFL-CIO lobbying garnered since LBJ was in the White House?

    1. Jody

      Trumka is not elected by union members. He is elected by the heads of the member unions, many of whom were also not elected by their members.

      1. NotTimothyGeithner

        I think the issue is structure of the unions. They are too big or maybe they shouldn’t be so united. At the end of the day, most unions will be placated. Promises of riches aside, for who does Trumka work? The answer is the majority of union members who need their jobs at any given time.

        Local chapters need to be re-empowered to act on their own and not wait for the central leadership of a hodge podge of different interests. Since Trumka isn’t elected directly, his real power is weak because he does not control the sub-bosses by being more popular. Trumka is an outsider to most union members because they didn’t vote for him, and in essence, he lacks the standing for a national or sympathy strike.

        Not organizational structure works, or it might have worked with the right personality or problems were ignored because of larger macro events. Fast food workers seem to have more energy despite lower incomes and less resources than the more established unions.

    2. s spade

      Wish I could care about the Unions. Big Labor has been selling out the non-union work force for eighty years. Who cares about 20 million over privileged screw turners? Has any one noticed the labor force includes 160 million people?

      What the country needs is a union including all labor. It might be harder for Obamacrats to f**k them over.

  6. Marsha

    A fine of $1200 a year for opting out of a questionnaire? I wonder what the fine will be if a woman lies on the questionnaire and then goes ahead and gets pregnant. No maternity coverage? A forced abortion (if there are any abortion provider still left)?

    1. diptherio

      Yet another way that a f-ed up bureaucracy turns us all into liars. If everyone can be encouraged to break a few laws or tell a few lies, then the PTB can be sure to have some “dirt” on everyone in the society, which assists with social manipulation immensely (…says the conspiracy theorist who lives inside my head…)

  7. Cynthia

    Nurses’ unions support single payer because it shifts money and power back to the clinical nurse working at the bedside. But because ObamaCare shifts money and power away clinical nurses and gives it to nurse mangers and other in so-called “leadership” positions, nursing management is very supportive of ObamaCare. Keep this in mind the next time you come to find out that administrative costs make up an even bigger portion of your hospital bill.

    And now that nurses have come to dominate the corporate suite in an increasing number of large hospital systems, I largely blame nursing leadership for all of this recent and excessive rise in administrative costs. This is why I would rather see hospitals run by physicians that have climbed the corporate ladder than by nurses that have climbed the corporate ladder. Physicians do the heavy lifting at hospitals. They do the curing, while nurses merely do the caring. Nurses know that not much money can be made in caring as it can in curing, so they look for other ways to make a profit for themselves. What better and more easier way to do this than to shift more money and power away from clinical nurses and give it to nurse managers, which only compounds the bureaucratic burden on hospitals. It sickens me how nursing management comes up with more and more bureaucratic boondoggle that don’t amount to anything. They are designed to feather the nest of those at the top in hospital management. They never result in better patient outcomes or reduced hospital stays.

    Don’t think I’m alone in thinking this, the Skeptical Scalpel, who’s a well-known and respected blogger in the medical blogosphere, fully agrees with me on this. We both don’t have many good things to say about nurses running hospitals. They tend to reward managerial skills over clinical skills. They create wasteful white elephant like “The Center of Nursing Excellence,” which is nothing more than corporate welfare program for master’s and doctorate prepared nurses. And most of all, they deserve most of the blame for hospitals becoming way too top heavy, which is causing administrative costs to outstrip the cost of providing care.

    I just wish that the Skeptical Scalpel and others like us could do something about it. In the meantime, the burden of bureaucracy coupled with all of the self-licking ice cream cones that are plaguing hospitals will eventually result in their demise, and the finger of blame will point directly at nursing leadership.

    1. Lambert Strether

      Thanks very much for this perspective; health care is such a huge industry — and thankfully I have hitherto had little direct experience with it. The process you describe sound exactly like what’s happening at universities, with a massive shift in spending away from teaching and research to a bloated, parasitical, and corrupt administrative layer of Deans and Presidents.

      1. nobody

        Of course “the process…sound[s] exactly like what’s happening at universities.” It’s all part of the same process.

        In the universities they are talking about the crisis in academia. At the medical conferences they are talking about the crisis in American medicine.

        What isn’t happening is people from the various domains coming together and describe what they see happening and putting two and two together.

    2. I'm Singing in the Reign

      Amen and amen to Cynthia. Having very close friends who work in clinical nursing, I have heard this story repeated almost verbatim. Senseless, duplicative and medically irrelevant form filling is becoming the major occupation of clinical nurses as patient care becomes something you shoehorn in when the paperwork allows. All to provide a nutrient-rich environment for a nursing management that couldn’t usfully employ a butterfly suture to save their life.

      America, the once indomitable home to the most creative, industrious and productive folks possible, is being eaten alive, in larger and larger gulps, by the economically sterile and fecklessly well-positioned “managers”. They are called managers because, against all the odds, they manage to eff up literally everything they touch.

    3. JTFaraday

      “Physicians do the heavy lifting at hospitals. They do the curing, while nurses merely do the caring. Nurses know that not much money can be made in caring as it can in curing, so they look for other ways to make a profit for themselves.”

      Puh-leeeeeze, Cynthia. My mother has an incurable, degenerative disease. No doctor has ever “cured” anything. But they still collect the big bucks.

      Are you sure you’re a nurse?

  8. Butch in Waukegan

    Ah! A “strongly worded letter”!

    It seems the strongly worded letter is the only arrow in the quivers of “progressive” leaders. During the Bush administration, every other month Henry Waxman wrote another another one. Yet in 2006, when the Democrats won the House and he had the power to investigate Bush, he couldn’t / wouldn’t write a subpoena.

    Speaking of letters, here’s an funny depiction of how ObamaCare is shaking out.

    1. NotTimothyGeithner

      This is SOOO inaccurate. Perhaps you need to get your facts in order because the fact is Henry Waxman went after the wealthy. Perhaps, you missed the grilling of ROGER CLEMENS, history’s greatest monster. He is also from Texas which is evil. Henry Waxman went after a New York Yankee. Have you ever heard of the Evil Empire? Waxman is a patriot concerned with the people’s business.

      Now, Democrats are making noise about HGH in the NFL.

  9. sellem

    It isn’t just that Obama holds the left responsible for splitting the party in ’68, or for being old-fashioned Dukakis/ Mondale losers who never got the Reagan memo.

    He’s always been on the other team.

  10. PghMike4

    Read the article by Klein; he points out, describing the union plans:

    “They receive the tax break given to employer-based plans and they often don’t follow “guaranteed issue” rules, meaning they don’t offer insurance to anyone who wants it. All of this disqualifies them from the insurance marketplaces and the associated subsidies.”

    If a plan isn’t following guaranteed issue, you *want* it killed. People would be better off in a real exchange plan, and by maintaining a larger pool in the exchange, you make the exchanges more healthy as well.

  11. Yancey Ward

    Obama would have loved to give in to the unions demands, but the costs of adding 20 million plans to those being subsidized was more than they thought they could get away with without having to go to Congress to beg for more money for Obamacare.

  12. TK421

    If only Obama had campaigned as hard for single payer as he did for Larry Summers or war with Syria.
    (I know he never would, I’m just saying.)

  13. Aidan

    This post is missing any sort of argument that acceding to the unions’ demands would be good public policy. I wonder why.

    1. Yves Smith

      You need to do better than that. An intellectually lazy swipe an unions isn’t going to get you very far here.

      The onus is on you to say why having Taft-Hartley plans excluded is a good idea if you think Obamacare is a good idea. Lambert has made clear in past poss why he thinks Obamacare sucks and single payer was a vastly preferable approach. The tone of your comment suggests you think screwing union members is a good idea. I see you are a first-time commentor and I’ve noticed how posts with the word “union” in it consistently attract drive-by commentors who take it upon themselves to reeeducate people who are supportive of organized labor.

      Breibart is over there.

      1. Yancey Ward

        Would acceding to the unions’s demands in this case be good public policy, or not? Of course, I don’t think Strether actually says or implies that in this post, but then I think you are a bit over the top in thinking that comment by Aidan was “anti-union” in the first place.

        1. NotTimothyGeithner

          I think it would be good for union members. On a macro scale, it might be splitting hairs, but it underscores the failure of Obama-care. Its not a policy which is a win for the population at large, and so even within the reforms of Obama-Care which is a celebration of the status quo, changes may be good at one level but they put the burden on people who can’t afford it.

          On the political level, it will create the notion that unions only exist for union members, and unions like so many are strongest when they exist for non-members which creates the notion unions are organizations which exist to beget themselves and grab tribute from members.

      2. Aidan

        Good lord. Lambert’s post depends on the assumption that if the unions are demanding a carve-out, it’s obviously good public policy. He doesn’t actually enunciate this, and he and the labor leaders themselves make the argument that they are owed a favor for helping Obama get re-elected. The fact that you assume that I’m anti-union or a Breitbart follower because I ask if this is a matter of optimal public policy or just raw power politics says more about you than it does me.

        Anyone who has ever read a Lambert post knows that he thinks Obamacare sucks and he prefers single-payer, but that isn’t relevant. The question here is if this particular carve-out is good general public policy or good for union members. I would like to hear the case for why this would be good public policy or why it is the responsiblity of the administration to alter the law to favor labor groups at the expense of good public policy.

        1. Lambert Strether

          As I point out, there’s no good public policy to be had, here; you can’t buff a turd. Good public policy is single payer, and the sooner enough people realize that the better.

          * * *

          Since what we have is a pigfest of rental extraction, with employers and health insurance companies muscling and shoving their way to the trough, I don’t see why all other entities involved in the process shouldn’t be able to try for the same goal. Obviously, Obama thinks some entities — large employers, health insurance companies, Congress — are more equal than others, but that should come as no surprise to anyone. So, since general ethical basis for all ObamaCare players is “I’ve got mine, now you get yours,” I don’t think pious protestations about public policy matter, and the unions should be allowed to follow the same rule with no pearl clutching.

          Were there to be a public policy aspect to this process, as there is not, I would try to avoid gutting unions. Obama, again, obviously thinks differently. Hopefully 20 million union members will notice, and the Democrats will go the way of the Whigs, as they so richly deserve to do.

  14. scraping_by

    The Holy Triumverate of MSM distraction is Sex, War, and Race. We’ve had, in the last couple months, Gay marriage (and Mily Cyrus), the aborted conquest of Syria, and Treyvon Martin. The question is, why?

    The onset of the ACA might be the fart that needs the perfume. Everyone can see, especially those who deny it, it’s a clusterfuck. The idea of significant groups getting pissed enough to stand on their hind legs and objecting or, even more alarming, agitating, might need some preventative screening.

    And if the outrage grows, if the hippies don’t stay punched, if levers of power are grasped, who knows? Maybe Barry will come out of the closet, an overage carrier might have a mysterious explosion (God forbid), or one of the stories in the alternate press about ‘This is for Trayvon’ murders might be juiced up to the whole newscast. It’s all a technology.

  15. Don Levit

    Cynthia:
    You are correct that the ACA does little to control costs.
    The primary way of lowering any insutance premium is to increase the deductible.
    Increasing the health insurance deductible to $25,000 reduces premiums 60%; a $50,000 deductible reduces premiums 80%.
    We have a patented product which funds the underlying deductibles for a very reasonable cost, patrticularly if one has dependents.
    We hope to make this product available within the next few months for self-funded employers and for fully insured plans in Texas next year.
    Don Levit

    1. scraping_by

      Actually, Don, there are several ways to lower premiums. 1.) Increase the risk pool to include lower cost patients. 2.) Lower the expectation for profit, including executive bonus and loan repayment. 3.) Negotiate cost-sharing with the provider, lowering their margin. 4.) Turn bill-padding into a criminal offense, rather than a tort, and so on.

      Obama-Gap insurance policies are an unsurpising development, but still point up who this whole public charade is designed to benefit. And it’s the cowboys, not the cattle.

      1. ian

        One thing you could start with would be how billing is done in hospitals. I don’t know if any of you have looked at the invoices from hospitals once the dust settles from the insurance company.
        I had a couple that went like:
        We are billing you $12,000
        The insurance company paid $2000
        You owe: nothing.

        (the numbers are from actual invoices I have had).

        The point is, with accounting like this, who the hell knows what something really costs?

  16. Bridget

    A Liberarian would tell you that there’s no reason to think that a single payer system would be any less intrusive. Cheaper maybe, but no less in your face at vey turn. It’s pretty much the nature of the government beast.

    1. Lambert Strether Post author

      Well, I know that’s what a Libertarian would tell me. Seems to work OK in Canada, though. I mean, I don’t see Canadian’s rising up en masse and demanding a US-style health care system at the ballout box. (No anecdotes about cross-border visits, please.) One difference is that single payer, considered as an architecture, does not deliberately multiply sites for rental extraction, which is what ObamaCare does.

      1. different clue

        Here’s a cross-border care anecdote but not the way you think. A co-worker who used to live in Canada complained to me about how she had to cross the border for something she could not have done there in a timely way. I asked her how much she had to pay for that. Oh! . . . CanadaCare paid for it. Oh? . . . then what was the problem?

      2. Bridget

        Ha! I have had my very own cross border experience with Canada’s health care system and found it to be quite charmingly low tech and laid back. I would definitely not count on that being duplicated on this side of the border, single payer or no. In fact, Canadians should count themselves very lucky if they can keep their government out of their private lives much longer in the face of the snooping technology that is fast developing.

  17. Doug Terpstra

    Damning analysis of ObamneyCare as always, Lambert. Here the Obama regime’s glaringly-selective sanctity of law and contracts is breathtaking in the worst way— just the sort of naked display of hypocrisy that we’ve come to expect. And yet even though this regime’s infectious corruption is now so mind-numbingly familiar, its mendacity still always leaves one slack-jawed. It feels like shock-and-awe doctrine, a calculated scheme to induce a sense of helplessness.

    Maybe a Daily Kossack could explain to us how the wicked Republicans are somehow behind this, that they are only pretending to repeal ObamneyCare, while in fact they are actually amending it to suit their investors contributors, and the chief executive officer, the commander in chief, is powerless to prevent them. In that spirit, I think if we all just work harder to push the Democrats and organize better to “make Obama heed his campaign pledges” we’d all get ponies before the midterms.

    In truth, Obama’s party is beyond reform or redemption; it must be finally and firmly renounced, denounced, and repudiated.

    1. s spade

      All obviously true. The only Democratic message remains ‘the other guy is worse so you have to vote for us’. Don’t bet it isn’t going to work for another 100 years.

      Personally, I look forward to President Hillary, who is the next thing to a drag queen IMHO. Can’t imagine anything more ridiculous, but I keep trying.

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